坎地沙坦酯联合苯磺酸左旋氨氯地平对高血压患者靶器官保护作用的研究

目的 探讨坎地沙坦酯联合苯磺酸左旋氨氯地平治疗高血压的疗效及对靶器官保护作用的研究.方法 2011年2月至2013年7月122例原发性高血压合并蛋白尿的患者,按随机数字表法分为观察组（61例）和对照组（61例）.两组患者均给予坎地沙坦酯片8 mg/d治疗,观察组在此基础上加用苯磺酸左旋氨氯地平2.5 mg/d.治疗6个月后观察两组血压水平、颈动脉内膜-中层厚度（IMT）、室间隔厚度（IVST）、左室后壁厚度（LVPWT）、左室舒张末期内径（LVEDD）、左室质量指数（LVMI）和肾功能各项指标的差异.结果 治疗后6个月,观察组总有效率为86.9％（53/61）,对照组为72.1％（44/61）,两组比较差异有统计学意义（P＜0.05）.两组治疗后收缩压和舒张压均较治疗前下降,差异有统计学意义（P＜0.05）,观察组治疗后收缩压和舒张压均低于对照组,差异有统计学意义（P＜0.05）.两组治疗后IVST、LVEDD、LVPWT、LVMI、颈动脉IMT均较治疗前显著降低,差异有统计学意义（P＜0.05）,观察组治疗后IVST、LVEDD、LVPWT、LVMI、颈动脉IMT明显低于对照组（8.5±1.3）mm比（9.2±1.2） mm、（39.6±4.8） mm比（44.3±3.9） mm、（8.4±1.4） mm比（9.1±1.3）mm、（89.4±9.3） g/m2比（97.3±8.9） g/m2、（8.3±0.3） mm比（8.7±0.5）mm],差异有统计学意义（P＜0.05）.两组治疗后尿素氮水平与治疗前比较差异无统计学意义（P＞0.05）,血清肌酐（SCr）、内生肌酐清除率（Ccr）、24 h尿白蛋白总量、尿微量白蛋白较治疗前显著改善,差异有统计学意义（P＜ 0.05）;观察组治疗后SCr、Ccr、24 h尿白蛋白总量、尿微量白蛋白较对照组改善更明显（94.6±25.5）μmol/L比（118.5±38.4） μmol/L、（102±24） ml/min比（96±18） ml/min、（1.05±0.51） mg/24 h比（1.27±0.22）mg/24 h、（155±36） mg/L比（185±41） mg/L],差异有统计学意义（P＜0.05）.结论 坎地沙坦酯联合苯磺酸左旋氨氯地平降压效果优于单药治疗,联合用药在逆转左室肥厚、改善颈动脉IMT、保护肾功能、降低尿蛋白方面效果显著,无明显不良反应,值得临床推广应用.

Research of candesartan combined with levamlodipine besylate on target organ protection in patients with hypertension

Objective To explore the effect of candesartan combined with levamlodipine besylate on hypertension and target organ protection.Methods One hundred and twenty-two patients with hypertension and proteinuria from February 2011 to July 2013 were divided into observation group （61 cases） and control group （61 cases） by random number table method.Patients in both groups were given oral candesartan 8 mg/d,and the observation group was treated with levamlodipine besylate 2.5 mg/d on this basis.Six months after treatment,the blood pressure levels,carotid intima-media thickness （IMT）,interventricular septum thickness （IVST）,left ventricular posterior wall thickness （LVPWT）,left ventricular end diastolic diameter （LVEDD）,left ventricular mass index （LVMI） and renal function between 2 groups were observed.Results After 6 months of treatment,the total effective rate in observation group was 86.9% （53/61）,and in control group was 72.1% （44/61）,there was significant difference （P 〈 0.05）.Systolic blood pressure and diastolic blood pressure levels in two groups after treatment were decreased,in observation group which were lower than those in control group,and there was significant difference （P 〈 0.05）.IVST,LVEDD,LVPWT,LVMI and carotid IMT in 2 groups after treatment was lower than that before treatment,in observation group which was obviously lower than that in control group （8.5 ± 1.3） mm vs.（9.2 ± 1.2） mm,（39.6 ± 4.8）mm vs.（44.3 ± 3.9） mm,（8.4 ± 1.4） mm vs.（9.1 ± 1.3） mm,（89.4 ± 9.3） g/m2 vs.（97.3 ± 8.9） g/m2,（8.3 ± 0.3） mm vs.（8.7 ± 0.5） mm],and there were significant differences （P 〈 0.05）.Urea nitrogen between 2 groups before and after treatment had no significant difference（P 〉 0.05）.The serum creatinine,creatinine clearance rate,total 24 h urinary albumin and microalbuminuria in 2 groups was significandy improved compared with that before treatment,and in observation group after treatment was obviously improved compared with that in control group （94.6 ±25.5） μmol/L vs.（118.5 ±38.4） μmol/L,（102 ±24） ml/min vs.（96 ± 18） ml/min,（1.05 ± 0.51） mg/24 h vs.（1.27 ± 0.22） mg/24 h,（155 ± 36） mg/L vs.（185 ± 41） mg/L],there were significant differences （P 〈 0.05）.Conclusions The effect of candesartan combined with levamlodipine besylate in treatment of hypertension and proteinuria is better than monotherapy.Combination therapy in reversing left ventricular,improving carotid IMT,protecting kidney function and reducing proteinuria has significant effect,and has no obvious adverse reactions.It is worthy of clinical application.